Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Ovarian stimulation for ovulatory disorders and assisted reproduction. From simple induction with oral medications till the controlled ovarian stimulation including different protocols.
Ovarian Hyperstimulation in Intrauterine InseminationElmar Breitbach
Intrauterine insemination is well established in the treatment of infertility. But which pretreatment leads to the best results? Do we have to trigger ovulation? What about luteal phase support? Whar patients do have the best chances? When do we have to switch to IVF?
Evidence based answers to these questions an a bit of experience based suggestions.
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
Discover the 5 essential steps for menopause hormone therapy, including benefits, risks, and how to make informed decisions for a smoother transition through menopause.
Learn about the connection between Polycystic Ovary Syndrome (PCOS) and Metabolic Syndrome. Discover symptoms, associated risks, and effective management strategies to improve your health and well-being.
Late onset menopause, or delayed menopause, refers to the cessation of menstrual periods and reproductive function occurring at an older age than the average onset of menopause, which is typically around 51 years old. When menopause occurs after the age of 55, it is considered late onset. This phenomenon is relatively rare, affecting a small percentage of women, and is influenced by various factors including genetics, lifestyle, and environmental factors.
A urinary tract infection (UTI) during pregnancy occurs when bacteria enter the urinary tract, leading to an infection. This condition is relatively common during pregnancy due to hormonal changes that can affect the urinary system, as well as the physical changes that occur as the uterus expands and puts pressure on the bladder. UTIs in pregnancy require prompt attention and treatment to prevent complications for both the mother and the baby
Discover the essential steps and expert advice for optimal pre-conception care. Learn how to enhance your fertility, ensure a healthy pregnancy, and lay the foundation for your baby's lifelong well-being
Explore the intricacies of ovulation induction in intrauterine insemination (IUI) with Dr Laxmi Shrikhande's informative slide share presentation. From understanding the hormonal mechanisms to the latest techniques, this presentation offers insights into optimizing fertility through IUI. Whether you're a clinician seeking to enhance patient outcomes or an individual navigating fertility treatments, this resource provides valuable knowledge for your journey towards conception.
Discover the keys to maintaining optimal health and vitality during midlife with our comprehensive guide to nutrition. Learn about the dietary choices and habits that support physical well-being, cognitive function, and emotional balance as you navigate through this transformative stage of life. From nutrient-rich foods to mindful eating practices, empower yourself to thrive at midlife and beyond.
In this informative presentation, we delve into the complexities of fever during pregnancy. Pregnancy brings about various concerns, and fever can be particularly worrisome. Join us as we discuss the causes, potential risks, and necessary steps to take if you experience fever while pregnant. Our expert provides valuable insights and practical tips to ensure the safety and well-being of both mother and baby. Don't let uncertainty overwhelm you; empower yourself with knowledge about fever in pregnancy and learn what steps to take next. Watch now to gain the guidance you need for a healthy pregnancy journey.
Unlock the secrets to vibrant health and vitality during midlife with our comprehensive guide on nutrition tailored specifically for women. Discover expert advice, science-backed strategies, and practical tips to support hormonal balance, bone health, metabolism, and overall well-being. Whether you're navigating menopause or simply aiming to thrive in your prime years, this SlideShare presentation is your roadmap to achieving optimal nutrition and vitality in midlife
Welcome to "Gestational Diabetes Mellitus (GDM): What Every Obstetrician Should Know"
Overview of the presentation's objectives and key topics to be covered
IVF Pregnancy -Is it different? A presentation by Dr Laxmi Shrikhande the leading IVF specialist in India
IVF (In Vitro Fertilization) pregnancy can be both similar to and different from natural conception in several ways. In IVF, fertilization of the egg occurs outside the body in a laboratory setting, typically involving the extraction of eggs from the ovaries and combining them with sperm in a petri dish. Once fertilization is successful, the resulting embryos are transferred to the uterus for implantation
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
A benign tumor of muscular and fibrous tissues, typically developing in the wall of the uterus.
Prevalence varies among studies and countries (4.5-68.6%)
Nearly 20-30% Indian women in reproductive age group have fibroid uterus
At any given time, nearly 15-25 million Indian women have fibroid uterus
Understand fibroids in a better way
Non-Specific Musculoskeletal Pain presented by Dr.Laxmi Shrikhande Consultant –Shrikhande Hospital & Research Centre Pvt Ltd
Nagpur. The leading hospital in Nagpur
This presentation covers the
1)Pain
2)Characteristics
3) Causes
4) Symptoms
You can get the awareness that you were looking for Non Specific Musculoskeletal Pain details
Non-Specific Musculoskeletal Pain presented by Dr.Laxmi Shrikhande Consultant –Shrikhande Hospital & Research Centre Pvt Ltd
Nagpur. The leading hospital in Nagpur
This presentation covers the
1)Pain
2)Characteristics
3) Causes
4) Symptoms
Contraception where have we been and where are we going is a presentation made by Dr.Laxmi Shrikhande who is a Fertility Specialist, Laparoscopic Surgeon & no scar Hysterectomy Specialist and a leading Gynaecologist from Nagpur
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Evaluation of antidepressant activity of clitoris ternatea in animals
Ovarian hyper stimulation syndrome ohss
1. Dr. Laxmi Shrikhande MD; FICOG; FICMU
•Director-Shrikhande Fertility Clinic, Nagpur
•President Menopause Society, Nagpur
•National Corresponding Editor-The Journal of Obstetrics & Gynecology of India
•Senior Vice President FOGSI 2012
•Vice Chairperson ICOG
•Governing Council member ICOG 2012-2017
•Governing Council Member ISAR 2014-2019
•Governing Council Member IAGE for 3 terms
•Patron-Vidarbha Chapter ISOPARB
•Chairperson-HIV/AIDS Committee, FOGSI (2007-09)
•Received Best Committee Award of FOGSI
•Received Bharat excellence Award for women’s health
•President Nagpur OB/GY Society 2005-06
•Associate member of RCOG
•Member of European Society of Human Reproduction
•Visited 96 FOGSI Societies as invited faculty
•Delivered 5 orations
•Publications-Twenty National & eleven International
•Presented Papers in FIGO, AICOG, SAFOG, AICC-RCOG conferences
•Conducted adolescent health programme for more than 15,000 adolescent girls
3. First reported in the early 1960s by Muller in
patients who developed the syndrome after
administration of pregnant mare's serum
gonadotropins
4. • Rare iatrogenic complication of ovarian stimulation
occurring during the luteal phase or during early
pregnancy.
• It is potentially fatal and is difficult to predict.
• Fortunately, the reported prevalence of the severe form
of OHSS is small, ranging from 0.5 to 5%.
Hugues J. Ovarian stimulation for assisted reproductive technologies, In: Current practices and
controversies in assisted reproduction. Geneva, Switzerland: WHO; 2001, p. 102–126.
5. • More over there is a significant increase in
pregnancy related complications among OHSS
affected pregnancies.
• There fore it is the responsibility of the
treating physician to be well aware of this
iatrogenic disease,
7. • mild- 20% and 33%
• moderate - 3 to 6%
• severe - 0.1 to 2%
• Only a few studies have compared the frequency
of OHSS after ovulation induction in IUI to the
frequency after IVF.
OHSS & Gonadotrophins for IVF
8. It seems, however, that serious OHSS is more
prevalent following ovarian stimulation for
IVF treatment rather than COS for non-IVF
purposes
OHSS & Ovulation Induction
9. Early onset OHSS
3 to 7 days after HCG
Excessive response to
stimulation
Late onset OHSS
12 to 17 days after HCG
Due to pregnancy
OHSS is preceded by multiple follicular development
combined with a high serum E2 concentration.
Lyons et al, Hum Reprod. 9: 792, 1994; Mathur et al, Fertil Steril 73: 901, 2000
10. CLASSIFICATION (Golan et al 1989)
MILD Grade 1: abdominal distension and discomfort
Grade 2: grade 1 + nausea,vomiting and/or Diarrhoea,
enlarged ovaries (5-12 cm).
MODERATE Grade 3: grade 2 + ultrasound evidence of ascites
SEVERE Grade 4: grade 3 + clinical evidence of ascites and/or
hydrothorax and breathing difficulties
Grade 5: grade 4 + haemoconcentration, increase
blood viscosity, coagulation abnormality and diminished
renal perfusion
Classification
11. MANAGEMENT-3 Ps
• PREDICTION
• PREVENTION
– Primary (before starting HMG/FSH)
– Secondary (after starting HMG/FSH and
before HCG administration)
• POST - OHSS MANAGEMENT
12. MANAGEMENT-3 Ps
• PREDICTION
• PREVENTION
– Primary (before starting HMG/FSH)
– Secondary (after starting HMG/FSH and
before HCG administration)
• POST - OHSS MANAGEMENT
14. Prediction
Good predictors Bad predictors
PCOS BMI
Young age Genetic predisposition
PCO pattern Serum VEGF
AFC Von Willebrand factor
E2 level on day of HCG Perifollicular blood flow
Insulin resistance
Large ovarian volume
AMH
15. PCO pattern to predict OHSS
Rizk and Smitz, Hum Reprod 7: 320, 1992;
Delvigne et al, Hum Reprod 8: 1353, 1993
16. Antral follicular count
• Count of total follicles measuring 2 to
5mm in both ovaries on Day 2/3 of
periods.
• Inter observer variation is a limitation.
• cycle to cycle variability
Tomas et al, Hum Reprod 12(2):220, 1997
17. AFC
• 2 D real time TVS by 7 MHz transducer is adequate
• Manual counting on stored 3 D images
• > 15 follicles –risk of OHSS
28. Reduced gonadotrophin
• Chronic low dose step up protocol results in
better pregnancy rates with reduced incidence of
OHSS compared to high dose regimens in IUI
cycles.
• Minimal stimulation / natural cycle IVF.
• Using r FSH instead of urinary FSH have no effect
in reducing the incidence of OHSS.
Cochrane Database of Systematic Reviews 2011
29. Antagonist protocol
• The use of antagonist compared with long GnRH
agonist protocols was associated with a large
reduction in OHSS and there was no evidence of
a difference in live-birth rates.
• The added advantage being possibility of using
agonist instead of HCG to trigger final oocyte
maturation.
Cochrane Database of Systematic Reviews 2011
30. GnRHa ( long)
n= 85
Cetrorelix
n= 188
P value
OHSS 6.5 % 1.1% 0.03 %
Pregnancy
Rate
26.0 % 22.0% NS
GnRH agonists vs GnRH antogonists
Ludwig e.a. 2001 Gynecol/obstet
31. In vitro maturation
• It is an attractive strategy to prevent OHSS in
PCOS patients. It involves earlier retrieval of
immature oocytes at the germinal-vesicle stage
followed by IVM & ICSI
• Though promising data on the IVM technique have
been published, unfortunately there is still no
evidence from RCTs upon which to base any
practice recommendations.
Cochrane Database of Systematic Reviews2013
32. Prevention of OHSS
Primary prevention (before starting
HMG/FSH)
Secondary prevention (after starting
HMG/FSH and before HCG
administration)
33. Late prevention (after starting HMG/FSH and before HCG)
• Cancellation of the cycle
• Coasting
• Diminish HCG dose
• GnRHa to trigger ovulation
• Metformin
• Albumin
• Cabergoline
• I.V. Calcium
• Cryopreservation of embryos
• GnRH agonists + embryo freezing
• Unilateral follicle aspiration before HCG
• Laparoscopic ovarian electro-cautery
34. Cancellation
• Cycle cancellation before administration of
HCG is an effective strategy for the prevention
of OHSS.
• May be acceptable in an IUI cycle but not in
an IVF cycle because of the financial burden
and psychological stress to the patient.
35. COASTING• Coasting involves withholding further
gonadotropin stimulation & delaying
hCG administration until E2 levels
plateau or decrease significantly
• There was no evidence to suggest a benefit of
using coasting to prevent OHSS compared with
no coasting or other interventions.
Cochrane Database of Systematic Reviews 2011
Coasting
36. Low dose HCG / R- LH
• The trigger of oocyte maturation with low dose
of hCG in high-risk patients reduces the risk of
OHSS. (kolibianakis et al 2007,ying et al 2013).
• No evidence of difference between rHCG or
rhLH and uHCG in achieving final follicular
maturation with equivalent pregnancy rates and
OHSS incidence.
Cochrane Database of Systematic Reviews 2011
37. Gnrh agonist trigger
• Use of GnRH agonists instead of HCG for trigger results
in a lower incidence of OHSS but extremely high early
pregnancy loss due to luteolysis.
• Luteal rescue is still possible with low dose hcg
(1500 IU) with comparable pregnancy rates and
minimal risk of OHSS. (humaidan et al 2012)
• GnRH agonist could be useful for cryopreservation & and
donor/ recipient cycles.
Cochrane Database of Systematic Reviews 2014
38. OVAIDING HCG FOR LPS• Progesterone, hCG or GnRH agonists are used for
LPS but use of hCG was linked to significantly higher
risk of OHSS.
• Progesterone seems to be the best option as LPS in
high risk patients with out the risk of OHSS.
Cochrane Database of Systematic Reviews 2011
Luteal Phase Support
39. Insulin sensitizers
• Metformin suppresses insulin levels &
decreases ovarian androgen
production with improved ovulatory
rates.
• Metformin treatment before or during ART
cycles decreased the risk of OHSS in PCOS
women.
Cochrane Database of Systematic Reviews 2014
40. IV Albumin vs HES
• There is limited evidence of benefit from intra-
venous albumin administration at the time of oocyte
retrieval in the prevention of severe OHSS.
• Where as Hydroxyethyl starch markedly decreases
the incidence of severe OHSS and this is a cheaper,
potentially safer alternative to albumin.
Cochrane Database of Systematic Reviews 2011
41. Review: R.C.T. : 7 studies identified
Conclusion: Clear benefit of IV Albumin in OHSS prevention
Albumin vs. placebo (at OPU) in severe OHSS prevention: a
Cochrane review
Albumin Placebo OR + 95% CI
Severe OHSS 4/193 (2.1%) 14/185(7.6%) 0.28(0.11-0.73)
Aboulghar e.a. Hum. Reprod 2003
42. Dopamine agonist
• Cabergoline appears to reduce the risk of OHSS in
high-risk women, especially for moderate OHSS. (0.5
mg daily for 8 days post hcg trigger)
• The use of cabergoline does not affect the
pregnancy outcome nor is there an increased risk of
adverse events.
Cochrane Database of Systematic Reviews 2012
43. CA GLUCONATE /
ANTAGONIST• Calcium infusion (10 ml of 10% IV Ca gluconate in
200 ml saline for 3 days post OPU) can effectively
prevent severe OHSS and decreases OHSS
occurrence rates. (Naredi & Karunkaran 2013)
• Antagonists 0.25 mg daily from day 5 -8 post OPU
with or without embryo transfer causes rapid
resolution of early onset severe OHSS.
(Lainas et al 2012,2013)
Calcium Infusion
44. Cryopreservation
• Cryopreservation involves freezing of all
embryos to be thawed & implanted at a later
date.
• Early OHSS may occur but it almost eliminates
the risk of late OHSS.
• Though reduced pregnancy rates from frozen-
thawed embryos was a concern, the
introduction of vitrification technique shows
promising results.
CDC Report 2005,Fertil Steril 2008
45. MANAGEMENT-3 Ps
• PREDICTION
• PREVENTION
– Primary (before starting HMG/FSH)
– Secondary (after starting HMG/FSH and
before HCG administration)
• POST - OHSS MANAGEMENT
46. MANAGEMENT
• Out patient management is the norm in mild to
moderate OHSS.
• Monitor hematological & renal parameters
• USG to asses severity of OHSS
• Adequate oral hydration to prevent
haemoconcentration / oliguria
• dopamine agonist to control early OHSS.
47. • Limit activity
• Weigh daily
• Monitor intake(1liter/day) and output
• Daily follow up
• Report if symptoms worsen or
weight gain > 1 kg /day
OUTPATIENT CARE
48. CRITICAL OHSS
• Multi disciplinary management in a intensive care unit
• Strict fluid & electrolyte management
• Crystalloids & HES for hydration
• IV albumin if required
• Thromboprophylaxsis
• Paracentesis/culdocentesis/pleuracentesis relieves
abdominal tension & dysnoea. It also promotes
diuresis & clinical resolution.
54. 'Spiritual blossoming' simply means
blossoming in life in all
dimensions.
Being happy, at ease with yourself
and with everybody around you.
Sri Sri Ravi Shankar
The Art of Living
Editor's Notes
Although several large studies demonstrated no significant difference in the incidence of severe OHSS between agonist and antagonist treatments, a 2006 Cochrane review demonstrated that GnRH-ant protocols seem to be shorter, simpler, yield good clinical results, and are associated with a significantly lower incidence of severe OHSS.[52]